Disclaimer

This article is educational only and is not legal advice. I am not a lawyer. For advice about your specific case and deadlines, consult a licensed Ohio attorney.

Detailed Answer: How an appeal of an insurance denial typically works in Ohio

1. Understand the denial

When an insurer denies a claim they should send a written denial explaining the reason. Common denial reasons after a minor accident include: the insurer says the injury pre‑existed, the injury is not covered under your policy, the claim lacks proof (medical records, bills), or the insurer alleges late notice.

2. Read your policy and the denial letter

Carefully read your insurance policy sections that define coverage, exclusions, notice requirements, and any internal appeal or arbitration clauses. The denial letter will often cite specific policy language or claim codes. Make a copy of the letter and flag any deadlines mentioned for internal appeal.

3. Gather and preserve evidence

• Accident documentation: police report or crash report (if any), photos of vehicles and scene, contact info for other driver(s) and witnesses.
• Medical records: initial ER or urgent care records, follow‑up notes, physical therapy notes, diagnostic imaging, and itemized bills.
• Communications: all letters, emails, voicemail transcripts, or notes of phone calls with the insurer. Save the denial letter and any claim numbers.

4. Use the insurer’s internal appeal process

Most policies allow you to ask the insurer to re‑review the denial. To do this:

1. Promptly send a written appeal that explains why the denial is incorrect.
2. Attach supporting records (medical evidence, bills, witness statements, photos).
3. Request the insurer’s claim file and an explanation of why they denied coverage.
4. Keep copies and send via a trackable method (certified mail or email with delivery receipt).

Note: the insurance company’s internal reconsideration is often required before any contractual arbitration in the policy, so follow the steps the insurer or policy requires.

5. File a complaint with the Ohio Department of Insurance

If the insurer does not resolve the appeal, you can file a consumer complaint with the Ohio Department of Insurance. The Department accepts complaints about improper claims handling and may investigate insurer practices or help facilitate a resolution. Start at the Department’s consumer page: https://insurance.ohio.gov/. For general statutory authority that regulates insurance practices in Ohio, see the Ohio Revised Code chapter on insurance: https://codes.ohio.gov/ohio-revised-code/chapter-3901.

6. Consider alternative dispute resolution (ADR) if your policy requires it

Many auto and health policies include an arbitration or mediation clause. If your policy requires arbitration, you may have to arbitrate rather than go straight to court. Review the policy for ADR terms and deadlines. Arbitration can be faster and less costly than litigation, but it has tradeoffs (limited appeal options).

7. Evaluate litigation (small claims or civil suit)

If internal appeal and administrative complaints do not work, you can consider suing:

• First‑party claims (you versus your insurer): often found as a breach of contract claim when the insurer refuses to pay a valid benefit under the policy.
• Third‑party claims (you suing the other driver’s insurer): if the other insurer denies liability for your injuries you can sue the at‑fault driver in court.

Small claims court may be an option for modest unpaid bills. For larger losses you will need to file a civil case in the appropriate Ohio court. Litigation deadlines and procedures vary by claim type and county—get legal help to determine the correct forum and timing.

8. Possible legal claims beyond denial

Potential causes of action can include breach of contract and, in some circumstances, claims related to improper claims handling. Whether a particular claim exists and how strong it is depends on the facts and Ohio law. Consult an attorney to evaluate whether you have additional remedies.

9. When to consult an attorney

Talk to a qualified Ohio attorney if:

• The insurer denies a legitimate claim and refuses to reconsider after you submit documentation.
• Medical bills mount and the insurer will not pay covered benefits.
• The claims process involves complicated questions of coverage, exclusions, or offsets.
• You must file suit, face arbitration, or the insurer’s conduct looks unfair or deceptive.

10. Example (hypothetical minor-accident fact pattern)

Hypothetical: You are rear‑ended at low speed. You visit urgent care the same day, receive a diagnosis of a soft‑tissue neck strain, and incur $2,100 in medical charges. Your insurer denies injury benefits, saying the records show a prior neck condition and that current complaints are not related. Practical steps:

1. Obtain the denial letter and policy wording on coverage and medical payment or PIP.
2. Ask your medical provider to write a causal opinion (linking treatment to the crash) and obtain all medical records.
3. Submit an internal appeal attaching the provider’s note, records, and a chronology linking the injury to the crash.
4. If denied again, file a complaint with the Ohio Department of Insurance and consult an attorney to determine whether to sue for breach of contract or proceed to arbitration.

Helpful Hints

• Act fast: begin the appeal and preserve evidence as soon as you receive the denial.
• Keep a claim log: note dates, times, names, and summaries of all communications with the insurer.
• Get written medical causation: a treating provider’s note linking symptoms to the crash is often persuasive.
• Request the insurer’s file: Ohio consumers can ask for the insurer’s claim file and notes to see why the adjuster denied coverage.
• Use certified mail or email receipts when sending documents to the insurer so you have proof of submission.
• Check your policy for ADR clauses—failure to follow required steps can block later legal options.
• If the insurer appears to engage in unfair practices, contact the Ohio Department of Insurance: https://insurance.ohio.gov/.
• Consult an attorney early if the insurer denies coverage despite clear evidence—attorneys can preserve rights and negotiate or litigate when appropriate.